Furthermore, many elderly people are not aware of how hard to exercise and also do not appreciate how much exercise they are capable of.

Exercise is one of the safest ways to improve health. Because of the decline in physical capability due to aging and age-related disorders, the elderly may benefit from exercise more than younger people. Exercise has proven benefits even when begun in later years. Basic, modest strength training helps elderly patients carry out activities of daily living. Many elderly patients need guidance regarding a safe and appropriate regular exercise regimen.

Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism

Most patients with relative contraindications can exercise in some form, although typically at lower levels of intensity and in more structured circumstances than other patients (see Cardiovascular Rehabilitation ). At times, shorter bursts of higher intensity exercise with rests between attempts can be more accommodating than sustained moderate-intensity exercise. The exercise program may be modified for patients with other disorders (eg, arthritic disorders, particularly those involving major weight-bearing joints, such as the knees, ankles, and hips).

Patients should be clearly told to stop exercising and seek medical attention if they develop chest pain, light-headedness, or palpitations.

Screening

Before beginning an exercise program, elderly people should undergo clinical evaluation aimed at detecting cardiac disorders and physical limitations to exercise. Routine ECG is not required unless history and physical examination indicate otherwise. Exercise stress testing is usually unnecessary for elderly people who plan to begin exercising slowly and increase intensity only gradually. For sedentary people who plan to begin intense exercise, stress testing should be considered if they have any of the following (1):

Exercise program

Variation (regular change in exercise to avoid overadaptation to the same stimulus, but also to avoid minor injuries due to repetitive actions)

Often a single program can be designed to achieve all exercise goals. Strength training improves muscular mass, muscular endurance, and strength. If strength training is done through a full range of motion, many exercises improve flexibility, and the enhanced muscle strength improves joint stability and, consequently, balance. Moreover, if rests between sets are minimal, cardiovascular function also improves.

Duration of
aerobic activity for elderly people is similar to that for younger adults, but exercise should be less intense. Usually during exercise, the person should be able to comfortably converse, and intensity should be ≤ 6/10 on a perceived scale of exertion. Elderly people who have no contraindications can gradually increase their target heart rate (HRmax) to the one calculated by use of age-based formulas.

Some deconditioned elderly people need to improve their functional abilities (eg, by strength training) before they will be capable of aerobic exercise.

Strength training is done according to the same principles and techniques as in younger adults. Lighter forces (loads/resistance) should be used initially (eg, using bands or weights as light as 1 kg or arising from a chair) and increased as tolerated. More aggressive training (the use of higher resistance initially) should be under the supervision of a qualified fitness professional.

To help increase
flexibility, major muscle groups should be stretched once daily, ideally after exercise when muscles are most compliant.

Balance training traditionally involves challenging the center of gravity by undertaking exercises in unstable environments, such as standing on one leg or using balance or wobble boards. Balance training can help some people with impaired proprioception and is often used in an attempt to prevent falls in the elderly. However, it is often ineffective because any balance activity is skill specific (eg, good balance while standing on a balance board does not improve balance in dissimilar activities). For most elderly people, flexibility and strength training exercises prevent falls more effectively. Such a program develops strength around the joints and helps people hold body positions more effectively while standing and walking. In people who have difficulty standing and walking because of poor balance, more challenging balance tasks (eg, standing on a wobble board) are simply likely to facilitate injury and are contraindicated.

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Although quantitative mathematical models can guide clinical decision making, clinicians often make clinical decisions based on pattern recognition and a subconscious integration of patient data with prior experience. Such informal reasoning is often vulnerable to several types of cognitive errors. Which of the following is an example of availability error (misestimating the prior probability of disease because of recent experience)?

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